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General NPI Number Information
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NPI Number | 1114960358
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Entity Type | Organization
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Legal Business Name | BLACKHAWK PLASTIC SURGERY, A MEDICAL CORP.
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 11/08/2007
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Provider Practice Location Address
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Address Line | 3600 BLACKHAWK PLAZA CIR
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City | DANVILLE
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State | CA
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Zip | 94506-4623
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Country | US
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Telephone | 925-736-5757
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Fax | 925-736-5763
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Provider Business Mailing Address
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Address Line | 11999 SAN VICENTE BLVD STE 440
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City | LOS ANGELES
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State | CA
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Zip | 90049-5131
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Country | US
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Telephone | 310-440-3131
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Fax | 310-472-9582
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Authorized Official
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Title or Position | OWNER
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Name | MR. STEPHEN J. RONAN
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Credential | M.D.
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Telephone | 925-736-5757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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